新生儿坏死性小肠结肠炎X线平片及CT表现分析  

Analysis of X-ray and CT manifestations of neonatal necrotizing enterocolitis

作　　者：袁西伟 江林 徐贵川 邱毅 YUAN Xiwei;JIANG Lin;XU Guichuan;QIU Yi(Department of Radiology,the First People’s Hospital of Zunyi,the Third Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou Province 563002,China)

机构地区：[1]遵义市第一人民医院(遵义医科大学第三附属医院)放射科,贵州遵义563002

出　　处：《实用放射学杂志》2022年第3期472-474,479,共4页Journal of Practical Radiology

摘　　要：目的分析新生儿坏死性小肠结肠炎(NEC)X线、CT征象.方法回顾性分析54例NEC的X线及CT表现,行数字X线摄影术(DR)43例,螺旋CT平扫+三维重建46例,以肚脐为中心将腹部分为4个象限区(左上腹Ⅰ区、左下腹Ⅱ区、右下腹Ⅲ区、右上腹Ⅳ区)观察肠壁积气分布范围及肠壁积气特征.结果肠壁积气X线征象为串珠征26例、轨道征23例、靶环征11例、线样征31例,肠壁积气局限性21例、弥漫性17例,CT征象为串珠征40例、轨道征27例、靶环征32例、线样征17例,肠壁积气局限性16例、弥漫性25例;肠腔充气扩大X线表现7例、肠腔液平面3例、肠腔网格状或筛孔状积气26例,肠腔充气扩大CT表现3例、肠腔液平面3例、肠腔网格状或筛孔状积气32例;肝内门脉积气X线表现5例、CT表现17例,X线及CT均未见肝外门脉、肝内外门脉同时积气征象;腹膜腔改变X线表现5例、CT表现11例.结论NEC肠壁积气X线、CT征象具有串珠征、轨道征、靶环征、线样征,CT扫描三维重建技术对这些征象的检出明显优于DR,为临床诊断、判断病情及外科手术提供可靠依据.Objective To explore the X-ray and CT characteristics of neonatal necrotizing enterocolitis(NEC).Methods The X-ray and CT manifestations of 54 cases with NEC were analyzed retrospectively,including 43 cases of digital radiography(DR)and 46 spiral CT plain scan+three-dimensional reconstruction.The abdomen was divided into four quadrants with the navel as the center(left upper abdomen areaⅠ,left lower abdomen areaⅡ,right lower abdomen areaⅢ,right upper abdomen areaⅣ)to observe the distribution range of intestinal wall gas and the characteristics of intestinal wall gas.Results X-ray characteristics of intestinal wall gas included 26 cases of beaded sign,23 cases of orbit sign,11 cases of target ring sign,31 cases of line-like sign,21 cases of localized gas of intestinal wall,and 17 cases of diffuse gas.CT characteristics were 40 cases of beaded sign,27 cases of orbit sign,32 cases of target ring sign,17 cases of line-like sign,16 cases of localized gas of intestinal wall,25 cases of diffuse gas.X-ray showed 7 cases of enlarged intestinal cavity,3 cases of intestinal fluid level,and 26 cases of grid or punctate gas accumulation in the intestinal cavity.CT showed 3 cases with enlarged intestinal cavity,3 cases with intestinal fluid level,and 32 cases with grid or punctate gas accumulation in the intestinal cavity.Gas accumulation in intrahepatic portal vein was found in 5 cases with X-ray scan and in 17 cases with CT scan.Both X-ray and CT showed no pneumoperitoneum in extrahepatic portal vein or in extrahepatic and intrahepatic portal vein simultaneously.The peritoneal cavity changed in 5 cases with X-ray scan and in 11 cases with CT scan.Conclusion The X-ray and CT characteristics of NEC intestinal wall gas have beaded sign,orbit sign,target ring sign,and line-like sign.The three-dimensional reconstruction technology of CT scan can detect these signs significantly better than DR.It has a great value for clinical diagnosis,judgment of the patient condition and treatment option.

关 键 词：新生儿 坏死性小肠结肠炎 数字X线摄影术 计算机体层成像 

分 类 号：R574.5[医药卫生—消化系统] R814.41[医药卫生—内科学] R814.42[医药卫生—临床医学]